Endurance and feelings of self-control and self-efficacy

The ability to respond with endurance behaviour in unpleasant or difficult situations is undoubtedly an important ability and may lead to an increase of feelings of self-control and high selfefficacy. In pain research, self-efficacy represents a set of cognitions predicting positive outcomes of medical as well as of psychological treatments (Nicholas 2007). In models of stress and coping (Zautra et al. 1995), pain is conceptualized as a stressor to which individuals show diverse adaptation patterns. Whereas cognitive responses to pain such as help-hopelessness are important precursors of feelings of loss of control and depression, several coping responses were positively associated with self-reported control. Based on a cross-sectional correlation study in 195 chronic pain patients, positive relations between the CSQ-factors ignoring pain sensations, increasing behavioural activity, diverting attention as well as for coping self-statements and reinterpreting pain sensations and feelings of control were reported (Haythornethwaite et al. 1998). Individual differences in pain coping, predicted the effects of experimentally induced controllability during heat pain stimulation in healthy individuals and indicate the critical role of prefrontal cortex areas (Salomons et al. 2004). More recently, two studies investigated the association between pain- related task persistence behaviour and basal adrenocortical activity represented by a neuroendocrinological stress parameter, such as level of salivary cortisol after awakening (Sudhaus et al. 2007, Sudhaus et al. 2009), both supporting the stress-reducing character of behavioural endurance. These data concerning the relation between endurance behaviour, pain-related stress and control provide preliminary support for the assumption of the AEM that behavioural endurance associated with effective distraction away from pain may have a stress-reducing short-term effect, potentially mediated by an increased sense of control and self-efficacy.

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